Consideraciones y diferencias en el tratamiento de un diente fusionado / Considerations and differences in the treatment of a fused tooth

Las malformaciones dentales referentes a bigeminismos, fusiones dentarias, etc. presentan una prevalencia que oscila de 0,5 a 5%, dependiendo de factores geográficos, raciales o genéticos. Ello puede comportar una modificación en el tratamiento a llevar a cabo en cada caso particular. La presencia de anomalias en la forma, tamaño y número de dientes es mayor en los llamados síndromes genéticos pediátricos, en muchos de los cuales el retraso mental es una característica asociada. El objetivo de este trabajo es analizar dos casos clínicos similares de fusión dentaria en un incisivo central y trazar un plan de tratamiento individualizado, diferente según las características de cada paciente. El primer caso clínico se trata de un niño de 9 años sano, que presentaba un incisivo central superior fusionado a un supernumerario. El diente fusionado presentaba dos raices independientes y convergentes con una única cámara pulpar, que fue tratado mediante endodoncia, odontosección y reconstrucción con composite de la corona, reservándose para un segundo tiempo el tratamiento ortodóncico. El segundo caso clínico se trata de un paciente de 27 años con una disminución psíquica severa, epiléptico, afecto de hiperplasia gingival con ausencia total de higiene oral. El tratamiento consistió únicamente en la resolución del problema periodontal mediante cirugía e instauración de un programa exhaustivo de prevención con normas de higiene oral, implicando a padres y personal asistencial. Como conclusión diremos que en la elaboración del plan de tratamiento odontológico a llevar a cabo en dos casos de fusión dentaria influye como factor determinante el grado de colaboración asociado a la disminución psíquica severa en uno de ellos, con lo que resulta un tratamiento completamente diferente en cada caso (AU)

Dental malformations relating to bigeminism, fused teeth, etc., have a prevalence of 0.5-5%, depending on geographic, racial or genetic factors. This in turn may influence the treatment to be provided in each case. Anomalies in the shape, size and number of teeth are more common in the so-called pediatric genetic syndromes, many of which are associated to mental retardation. The present study describes two clinical cases of similar dental fusion involving a central incisor and comprising different and individualized treatment plans due to the important differences in the characteristics of each patient. The first case corresponded to a healthy 9-year-old boy with a fused upper central incisor and a supernumerary incisor in the second quadrant. The fused tooth presented two independent and converging roots with a single pulp chamber. Endodontic treatment was provided, with dental sectioning and composite reconstruction of the crown. Orthodontic management was reserved for a second stage. The second patient was a 27-year-old male with severe mental retardation of uncertain origin, gingival hyperplasia, a large bilobular upper central incisor, and a total lack of oral hygiene. Treatment in this case was limited to surgical resolution of the periodontal problem and the introduction of an exhaustive prevention program involving instructions for oral hygiene (with implication of the parents and care takers). In conclusion, the development of a management plan in these two cases of fused teeth required due consideration of the degree of patient cooperation, which was severely limited in one case - thereby causing treatment to differ greatly from one individual to another (AU)

Considerations and differences in the treatment of a fused tooth.

Dental malformations relating to bigeminism, fused teeth, etc., have a prevalence of 0.5-5%, depending on geographic, racial or genetic factors. This in turn may influence the treatment to be provided in each case. Anomalies in the shape, size and number of teeth are more common in the so-called pediatric genetic syndromes, many of which are associated to mental retardation. The present study describes two clinical cases of similar dental fusion involving a central incisor and comprising different and individualized treatment plans due to the important differences in the characteristics of each patient. The first case corresponded to a healthy 9-year-old boy with a fused upper central incisor and a supernumerary incisor in the second quadrant. The fused tooth presented two independent and converging roots with a single pulp chamber. Endodontic treatment was provided, with dental sectioning and composite reconstruction of the crown. Orthodontic management was reserved for a second stage. The second patient was a 27-year-old male with severe mental retardation of uncertain origin, gingival hyperplasia, a large bilobular upper central incisor, and a total lack of oral hygiene. Treatment in this case was limited to surgical resolution of the periodontal problem and the introduction of an exhaustive prevention program involving instructions for oral hygiene (with implication of the parents and care takers). In conclusion, the development of a management plan in these two cases of fused teeth required due consideration of the degree of patient cooperation, which was severely limited in one case -- thereby causing treatment to differ greatly from one individual to another.